Tragic news from Boston a few weeks ago. Dr Michael Davidson, a cardiothoracic surgeon at Brigham and Women's Hospital was gunned down outside his clinic by a deranged family member of one of his former patients.

Stephen Pasceri was a licensed gun owner, without a history of violence, who strode into Dr. Davidson's clinic, asked to speak to with him, and, upon Davidson's harried appearance (in the middle of a busy office hours) proceeded to assassinate him in broad daylight. Pasceri then ended his own life shortly thereafter.

The backstory was that Dr. Davidson had recently cared for Pasceri's mother. There were complications after a procedure, she passed away. Pasceri would have probably articulated his psychotic break as an "act of retribution". Which is bullshit, of course. Several years prior to this heinous episode, he had drawn attention to himself after the death of his father regarding a bill for services rendered after his dad had been emergently transported to the hospital following a massive myocardial infarction. The old man had refused Medicare part B and the estate received a bill for 8 grand after the funeral.

We live in very strange times. Much has changed since I entered medical school 18 years ago. The rise of Twitter, Facebook, on-line persona, patient satisfaction scores, and physician rating websites has, in addition to our incoherent medical malpractice system and a tendency from the medical profession to avoid transparency and accountability, led to a very confrontational and compromised patient/physician relationship. A certain wariness has crept into the patient/physician encounter. A doctor thinks to herself: "did I document our communication properly? Is there anything I said that a plaintiff's attorney could exploit?". A patient thinks: "Is what she told me accurate? Do I need to Google and Yelp and check Angie's List about the veracity of that visit?" It's like an encounter between an adult child and a father who abandoned his family years ago. The child wants to trust but is doubtful, the father wants to gain the confidence of the child but feels impeded by an impenetrable wall. Where do we go from here? How to bridge the chasm? A man without a history of mental illness, a neighbor, an accountant, a regular freaking guy, decided that his best course of action, in the throes of grief following his mother's death, would be to gun down the doctor who cared for her. Rhetoric is not harmless. We have spent years demonizing the medical profession as a bunch of money grubbing, greedy, unethical assholes. See, President Obama's speech in 2009 that libelously claimed surgeons intentionally chopped off diabetics' legs for a 40 grand payoff rather than perform the preventative care measures that paid a pittance. Americans have grown to expect perfection. We have government mandated "Never events". All complications are errors. Poor outcomes are the result of physician negligence. Full stop. The enemy is the man in the white coat. Why are we surprised that an average, disgruntled accountant would resort to vigilante justice? Violence is all around us, like the haze of a 1970's family living room. American Sniper is a hero. The Iraq War was justified. 9/11, you see. Aurora. Newtown. Drones. We have grown numb. A surgeon is dead in Boston. A widow with three children and a fourth on the way mourns. She must go on. We go on. The Super Bowl is today. Katy Perry. Michael Davidson will fade from the collective memory. Another dozen doctors are being rated online. Monday morning, another full office awaits. I better have my A-game.